Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts ThPpE2154-ThPeE7779 535

adequate. Some health care providers showed open contempt for injection drug
users by verbally expressing their negative views, refusing pain medication, demanding a fee for treatment that should be free, and breaching the patient's confidentiality. Injection drug users claimed to have received little or no information
about available treatments. Injection drug users know that health professionals
are apprehensive about IDU, fearing physical harm and occupational exposure to
HIV/HCV.
Conclusions: The stigma of IDU and/or HIV infection is causing many to keep
their stigmatizing attribute a secret and prevents many from seeking HIV testing and medical care. Stigmatization is resulting in the rapid spread of infectious
diseases among IDUs and non-drug users. Focus groups participants suggested
a number of solutions to address the problem including training and educating
health care professionals about drug addiction and HIV infection.
Presenting author: Victoria Orekhovsky, c/o Casey House, 9 Huntley Street,
Toronto, Ontario, M4Y 2K8, Canada, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPpE2154 The nature and extent of AIDS discrimination in
South Africa
ML. Richter. AIDS Law Project, Private Bag 3, University of the Witwatersrand,
Wits, 2050, South Africa
Background: South Africa's explosive AIDS epidemic is coupled by extreme levels of discrimination against people living with HIV/AIDS. AIDS discrimination is
particularly prevalent in South Africa's workplaces, health and insurance sectors.
Methods: The study chiefly draws on the experiences and cases of the AIDS Law
Project over the period 1993-2000. The AIDS Law Project is a legal NGO that specializes in HIV/AIDS and the law, and has been on the forefront of HIV/AIDS public
litigation and policy-change issues. The multifaceted nature of AIDS discrimination is explored by considering different forms and sources of AIDS discrimination,
while South African laws and policies relating to HIV/AIDS are examined in particular. A number of South African AIDS workers were also interviewed and a
survey of newspaper articles reporting on HIV/AIDS was conducted. This study
also draws on literature relating to discrimination and prejudice in general.
Results: South Africa has an AIDS discrimination problem of tremendous magnitude. Although a number of key laws and policies have been enacted, AIDS
discrimination continues to have an insidious impact on the private and public
lives of people living with HIV/AIDS, and on South African society as a whole.
This study illustrates how a sound legal framework is ineffective without public
education on human rights, legal remedies and mechanisms.
Conclusions: AIDS discrimination takes on a variety of forms and can be resisted
by the utilisation of human rights in particular. Recommended strategies to deal
with AIDS discrimination include mainstreaming HIV/AIDS, projecting positive images of people living with HIV/AIDS and imposing penalties for AIDS discrimination. Above all, visible and accessible campaigns centering on human rights and
the working of the law should be coordinated and sustained. This should be done
so that all people can utilise and benefit from the protection offered by the law.
Presenting author: Marlise Richter, Private Bag 3, University of the Witwatersrand, Wits, 2050, South Africa, Tel.: +(27) (11) 717-8633, Fax: +(27) (11) 403 -2341, E-mail: [email protected]
ThPpE2155 Operational research agenda on stigma and
HIV/AIDS in Southern and Eastern Africa
N.E. France1, S. Anderson2. 1Health & Development Networks, Chiang Mai,
Thailand; 2UNAIDS, Pretoria, South Africa
Issues: Stigma, characterised by silence, fear, shame and denial - fuels the
spread of HIV/AIDS. It undermines prevention, care and support and also increases the impact of the epidemic on individuals, families, communities and nations. While stigma is recognized as a problem, surprisingly little has been done
to systematically reduce HIV/AIDS-related stigma and it has not been extensively
studied. A better understanding of the social, cultural and psychological roots of
stigma is needed to inform political and religious leaders, health care providers,
PWHAs and the media. This paper presents an operational research agenda for
HIV/AIDS-related stigma in Southern and Eastern Africa.
Description: The overall aim of this project was to facilitate the development of an
operational research agenda on stigma and HIV/AIDS in Africa, by using a variety
of broad-based, innovative and standard participatory methods. These included:
a literature review; a structured and moderated debate using the e-mail discussion forum "Stigma-AIDS" with over 1200 members; focus group/key informant
discussions and a regional consultation meeting with over 80 participants.
Lessons learned: A concrete operational research agenda on stigma and
HIV/AIDS was developed, highlighting key research questions and key areas for
intervention in six specific areas related to stigma: Definition and context; health
care sector; people living with HIV/AIDS; religious sector; communication; and
indicators to measure stigma. This project also shows the impact of combining

innovative strategies such as electronic networking, together with other standard
strategies in enhancing participation and forming consensus on important, but
neglected topics.
Recommendations: People working in the field of HIV/AIDS are using the research agenda as a tool to plan practical operational research to better understand and reduce the impact of stigma on people living with HIV/AIDS.

Presenting author: Nadine France, PO. Box 173, Chiang Mai University Post
Office, Huay Kaew Rd, Chiang Mai, 50200, Thailand, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPpE2156 Socio-economic characteristics of HIV infected
patients in relationship with their access to
antiretroviral treatment, in the context of HIV/AIDS
Drug Access Initiative in Ivory Coast
J. Prudhomme1, A. Juillet2, P Msellati3, J.P. Moatti4. IlNSERM U379/ORS
PACA, 23 rue Stanislas Torrents, 13006 Marseille, France; 2ANRS / IRD,
Abidjan, France; 31RD/LPE, Marseille, France; 4/nserm U 379, Marseille, France
Context: The UNAIDS HIV Drug Access Initiative has been launched in August
1998.
Objectives: Describe socio-economic characteristics of HIV+ patients in relationship with ARV access in the Initiative.
Methods: A cross-sectional study among HIV+ patients have been carried out
from December 1999 to April 2000 in 8 health structures taking care of HIV+ patients. A detailed questionnaire has been filed in and CD4 cell counts were also
obtained. Statistical analyses were performed using SPSS and STATA.
Results: among the 1087 HIV+ patients coming to the health structures, questionnaire have been proposed to 745 patients and 711 agreed to answer. 241 of
them were included in the Initiative (101 were waiting for ARV), 23 were out of the
Initiative with ARV treatment and 446 were out of the Initiative without ARV. Patients out of the Initiative without ARV had lower socio-economic status than the
others: low school level, life in collective housing (62% vs 31%), without a fridge
(71% vs 33%) or direct access to tap water, low access to health insurance (11%
vs 33%), recent knowledge of their HIV status (57% less than 9 months vs 34%),
without a cotrimoxazole prophylaxis. Among the patients with less than 500 cd4,
the proportion of patients below 200 cd4 is similar among groups. In the multivariate analysis, factors independently associated with being out of the Initiative
without ARV were: being man, lack of fridge and ventilation, lack of participation
for the health expenditures in the family during the last
2 months, lack of cotrimoxazole prophylaxis, knowledge of their serostatus for
less than 9 months.
Conclusion: In spite of an equity effort realised in the UNAIDS Initiative in Ivory
Coast, people out of the Initiative and untreated are clearly from a very poor social and economic background. Information about cotrimoxazole prophylaxis and
an access to care must be more systematically frequent, particularly out of the
Initiative accredited centers.
Presenting author: Johanne Prudhomme, 23 rue Stanislas Torrents, 13006 Marseille, France, Tel.: [phone], Fax: [phone], E-mail: prudhomme
@marseille.inserm.fr
ThPeE7779 Empowerment strategies and AIDS prevention
among fishermen's wives in San Antonio, Chile
C.A. Donoso Orellana, F.J. Vidal Velis. VIVO POSITIVO, Juan Gomez Millas
2565 Depto. 15 Nunoa., Santiago, Chile
Issues: This project was financed by GLAMS. It is a research-based intervention
address to women married or living with fishermen in San Antonio. Most of them
work also in fishing labors. This group was selected since they are increasingly
at risk. The project was aimed at get women's empowerment in sexual health
issues, especially AIDS prevention.
Description: First, a research was conducted to determinate problems related
to sexuality and AIDS prevention. Both quantitative and qualitative methodologies were used. We worked with three women's organization of fishing labors.
The most important outcomes from the research were: women do not think themselves at risk of HIV/AIDS, since they have "only partner". But, at the same time,
they know their partners have usually sex with another ladies or men, especially
sex workers. They are not able to talk about sexuality with them. They have
many difficulties in adopting preventive strategies and self-care actions. Secondly,
we designed and performed two workshops, from the results of the research. In
these workshops we talked openly about body and sexuality, gender, skills about
AIDS, empowerment and negotiation of safe practices. Their objective was to give
women practical kills/tools to protect themselves since their own cultural values
and beliefs.
Lesson learned: Women evaluated the project positively, since that they felt they
could talk openly about sexuality as never before. Also, they said after it they felt
themselves able to discuss about it with their partners. For us, this project showed
how important is a research based intervention, to reach culturally appropriate
strategies.
Recommendations: We think this experience can be replicated with another
women's groups. This project showed it is a good strategy to work with preexisting women's organizations. Also, we did miss appropriate written material
on AIDS prevention for women, so they should be considered in the future.

Presenting author: Carla Donoso Orellana, Juan Gomez Millas 2565 Depto.
15 Nunoa., Santiago, Chile, Tel.: [phone], Fax: [phone], E-mail:
cadonos @ hotmail.com